Cholesteatoma

Cholesteatoma is an accumulation of squamous epithelium and keratin debris that usually involves the middle ear and mastoid.

Although benign, it may enlarge and invade adjacent bone.

Often presents with a malodorous ear discharge with associated hearing loss.

Diagnosis is clinical based on history and otoscopic findings. CT scan of the temporal bone, provides lesion definition and extent.

Treatment is surgical removal. Adjunctive topical antimicrobial treatment may help reduce acute symptoms preoperatively.

Complications include hearing loss, recurrence, meningitis, facial palsy, and a labyrinthine fistula.

Cholesteatoma is defined as the presence of keratinizing squamous epithelium within the middle ear, or in other pneumatized areas of the temporal bone.[1]Fisch U, May JS, Linder T. Mastoidectomy and epitympanectomy. In: Fisch U, May JS, Linder T, et al. Tympanoplasty, mastoidectomy and stapes surgery. 2nd ed. Stuttgart, Germany: Georg Thieme Verlag; 2007:152-160. This keratinizing epithelium exhibits independent growth, leading to expansion and to resorption of underlying bone.[2]Lesser TH. Cholesteatoma. In: Roland NJ, McRae RD, McCombe AW, eds. Key topics in otolaryngology. 2nd ed. Informa Healthcare; 2001:35-37. Focal erosion of external canal bone with accumulation of keratin is called external canal cholesteatoma.[3]Heilbrun ME, Salzman KL, Glastonbury CM, et al. External auditory canal cholesteatoma: clinical and imaging spectrum. AJNR Am J Neuroradiol. 2003 Apr;24(4):751-6. http://www.ajnr.org/cgi/content/full/24/4/751 http://www.ncbi.nlm.nih.gov/pubmed/12695217?tool=bestpractice.com